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Breathlessness, also called shortness of breath or dyspnoea, is the feeling a person gets when he or she finds it difficult or uncomfortable to breath. It is a personal feeling made up of several different sensations, including sometimes fear or anxiety, and quite different from the signs of the way that a person breathes that are audible or visible to others, such as wheezing or rapid breathing.

Breathlessness is normal in healthy people when they exercise, but it can be a sign of illness if it occurs at a low level of activity. As there can be many different reasons for breathlessness, if a person does experience shortness of breath as a new feeling or if the person's breathing is getting more difficult, it is important that he or she sees a doctor to find its cause.
In general, breathlessness is a signal that there is insufficient oxygen to satisfy the body's needs. It can occur when there is an increased demand for oxygen, for example during exercise, or when the lungs, heart and circulation are not working properly.

The lungs, heart and circulation normally all work together to supply the muscles and other organs of the body with the oxygen they need. When the lungs, heart and circulation are not working normally, the body is unable to maintain the body's requirement for oxygen. This causes breathlessness. The unpleasant sensation of being short of breath may trigger a sense of fear of suffocation, creating anxiety or panic. The person may tense the muscles in the chest, neck and shoulders, in an attempt to make breathing easier, but as these muscles are not designed to work continuously for long periods they soon become tired. All of these sensations make the person even more aware of their breathlessness, so creating and reinforcing a vicious circle

Physical fitness
The most common cause of breathlessness is being unfit. Ideally, everyone should do at least 30 minutes of vigorous exercise everyday. The reality is that many people seldom do any exercise. Taking the car instead of walking, taking the lift instead of climbing the stairs, sitting too long in front of the television etc, over the years all have an effect of reducing fitness levels. As the level of exercise falls, so too does the efficiency of the muscles, lungs and heart. Compared to someone who is physically fit, an unfit person has to work harder to produce the same effect. Working harder requires more oxygen and so an unfit person will become breathless much sooner than a fit person. When people do less exercise they tend to eat more and tend not to follow a healthy diet. As the pounds pile on, the body has to do more work and use more oxygen to carry the extra load.

Lung problems
There are a number of conditions that can affect the efficiency of the lungs and make breathing difficult that contribute to the sensation of breathlessness.

People who suffer from asthma may suddenly become breathless when they get an asthma attack. Trigger factors such as allergens (pollen, moulds, animal fur), exercise or cold air, cause the airways in the lungs to narrow, restricting the flow of air and so making breathing difficult.

People who smoke or who have been exposed to industrial pollutants during their working lives may also develop a condition called chronic obstructive pulmonary disease or COPD. The smoke or other harmful substances damages the airways and they become swollen and narrow. Large amounts of sticky mucus are also produced in the airways, narrowing them still further. If smoking or exposure to the pollutants continues, breathing gets more difficult and the person becomes progressively more and more breathless. People with COPD are also at high risk of getting chest infections. If a chest infection occurs a person can become breathless suddenly because the airways have difficulty coping.

Other causes
There are a number of other serious diseases that can affect the lungs and cause breathlessness. Among them are pneumonia, cystic fibrosis and lung cancer.

Heart problems
Strange as it may seem heart problems may also cause breathlessness. Heart failure, in particular a condition called left ventricular failure or LVF, is one of the most common causes and tends to cause breathlessness at night or when lying down.

In LVF, the left side of the heart does not work efficiently and it is unable to clear the blood it receives from the lungs. As a result, blood and fluids can build up in the lungs, sometimes quite quickly. LVF can cause anything from mild breathlessness at night to a very severe and sudden medical emergency called pulmonary oedema.

Other heart problems
Many other heart problems can also make breathing difficult. Among them are cardiac arrhythmia (an irregular heart beat), ischaemic heart disease (insufficient oxygen to the heart muscle usually caused by narrowing of the coronary arteries) and valvular heart disease (the valves within the heart and at the entrance to the major arteries leaving the heart, not closing properly).

When oxygen is carried in the blood, it is carried by the red blood cells attached to a special protein called haemoglobin. If there is less than the normal number of red blood cells or less than the normal quantity of haemoglobin, the oxygen carrying capacity of the blood is decreased. This condition is called anaemia and it restricts a person's level of activity. If through increased physical activity the amount of oxygen required exceeds the amount of oxygen that can be carried in the blood, the person will experience breathlessness
Pain relief during labour
Giving birth can be a painful experience, and every woman experiences pain differently. Nowadays there is a wide range of pain relief options available.

1. Entenox is the most commonly used. Most people know it as gas and air, though it is composed of half oxygen and half nitrous oxide (laughing gas). This is breathed in through a mask or mouthpiece, and works by acting on your brain to reduce pain, and can bring almost immediate relief. Many women find gas and air enough to cope with labour. 2. Pethidine is a narcotic that changes the way you feel about pain. It is injected into the thigh and starts working within 10 - 20 minutes, and wears off after an hour or two. Pethidine can cross the placenta after about two hours, and affect the baby, so its use is limited. It can be very useful if you have had a long labour and need to rest, as women often sleep between contractions. It does not however take away all the pain and can make you feel sick, sleepy and disoriented.

3. For full pain relief, an epidural is the best option. An epidural is an injection of anaesthetic plus painkiller into the gap around your spinal cord in the lower back. It takes about half an hour to set up an epidural and must be done by an anaesthetist, which means you might not always be able to have one when you want it, if the anaesthetist is busy elsewhere. With an epidural all the nerves are numbed from the waist down, and lasts about two to three hours, but it can be topped up by your midwife.

4. Another popular option in early labour is a TENS machine, which can be bought or hired from pharmacies or from a number of mail order outlets. TENS stands for Transcutaneous Electrical Nerve Stimulation, and is a small battery operated device with leads attached to it, leading to small sticky pads which when placed on your back send an electrical impulse to your nerves. At low frequencies, the impulses help release endorphins, the body's natural painkillers. At higher frequencies, these impulses prevent pain messages reaching the brain.

5. Another method of pain relief is relaxing in a warm bath, which can be very effective at relieving labour pain. Many labour wards now have ensuite bathrooms. Some expectant mothers choose a 'water birth' and spend their entire labour in a birthing pool. Many hospitals now have birthing pools but most usually insist that a specially trained midwife is around to supervise. You can also hire birthing pools to use in the home. Some women also find acupuncture and massage help with the pain. Whatever you decide in the end, it is a good idea to write down your preferences in your birth plan, so that all the personnel involved in your labour know what you would like.
Everyone is familiar with the increase in the rate and depth of breathing that follows exercise, but breathlessness can be something more. It can be the unpleasant sensations of fear and anxiety that accompany being unable to get one's breath. The person can feel like he or she is drowning. The feelings can be so unpleasant that the person affected naturally tries to avoid them and so will limit his or her activities. As time goes by, the person can become progressively less active and, eventually, may lose the physical ability and confidence to go out of the home, becoming reliant on others.
Although treatment will depend on the cause of the breathlessness there are a number of steps that you can take to avoid breathlessness or to help you breathe more easily.

Try to remain active. If you have not exercised for a long time, ask your doctor if it is safe to do so. Take it steadily at first and build up your level of activity gradually, for example by walking a little further each day. If you are overweight, try to lose a few pounds. Talk to your doctor if you need help losing weight. As your level of fitness improves you will find that you feel better and are able to accomplish much more.

Asthma sufferers
If you suffer from asthma, try to avoid situations or things that can trigger your asthma attack. Use your preventer inhaler regularly. If you find that you are using your reliever inhaler more often than you used to or it does not seem to be as effective, make an appointment to see your doctor or asthma nurse as it may be a sign that your asthma is getting worse.

If you are a smoker, do not ignore that cough or chest infection as they are possibly early signs of COPD. Try to stop smoking. Your pharmacist or doctor will be able to provide you with the support that you need to help you quit.

If you have heart failure
If you are being treated for heart failure but still have a tendency to become breathless at night or when lying down, tell your doctor as your treatment may not be adequate. Further relief of symptoms may be achieved by using more pillows in bed at night to raise the level of your chest slightly.
When to consult your doctor
The causes described above are just a few of the common conditions that cause breathlessness, but they still need to be checked by your doctor. Also, as breathlessness can be a symptom of many other different types of condition, it is important that you see your doctor to find the cause.

See your doctor if:

  • you experience shortness of breath as a new feeling
  • your breathing is getting more difficult
  • you make a noise on breathing
  • you seem more breathless than you would expect given your weight and level of fitness
  • you suffer symptoms such as dizziness

Although the unpleasant sensations associated with being short of breath are personal feelings known only to the person affected, your doctor will try to assess the level of breathlessness. Your doctor may use a scoring system that takes into account whether breathlessness came on suddenly or slowly, when it occurred and how

long it lasted. Your doctor will also look for reasons that may have caused the breathlessness or how much exercise causes breathlessness. You may be asked questions about your life-style. By taking a full medical history and examining you, perhaps taking a blood sample or referring you to a hospital for further tests, your doctor will be able to determine the cause of your breathlessness and will treat the condition appropriately.
what to do in an emergency
You should go to the hospital straight away if your breathing quickly gets a lot worse. Get urgent medical help if you suddenly find it hard to walk or talk, your lips or fingertips turn grey or blue, your heartbeat or pulse is irregular, or your medicine does not work for very long, or does not work at all.
Useful Tips
  • Try to remain active
  • Learn to relax when you get an attack of breathlessness
  • Remind yourself that breathlessness itself is not dangerous
  • Avoid tensing muscles in your jaw, chest, shoulders and neck
  • Learn efficient breathing techniques - such as abdominal breathing
  • Breathe in and out slowly through the nose or gently through the mouth
  • Breathe more deeply
  • Adopt a position, when standing or sitting, that you find makes it easier to breathe
  • Plan your activities so that you have plenty of time
  • Rest when you feel the need to do so
  • Stay cool using a fan or cold flannel to the face
  • Ensure that your room is well ventilated
  • If you smoke, try to give up; talk to your pharmacist or doctor for help and advice
  • Avoid smoke and do not allow others to smoke in your presence
  • If overweight, try to lose a few pounds; talk to your doctor if you need helping losing weight

SPI/SPV2236 Date of Prep: December 2009

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